Implementation of a clinical pathway for the evaluation of asymptomatic hypertension in the emergency department.

Introduction: According to the guidelines of the American Heart Association and American College of Emergency Physicians, respectively, there is no indication for immediate lowering of asymptomatic hypertension in the Emergency Department (ED), and no requirement for routine diagnostic testing in these patients. Despite this, asymptomatic hypertension represents a recurring source of referrals for ED evaluation from other healthcare settings, or from patient self-referral, with significant practice variation in the evaluation and treatment of this complaint.

Methods: This is a pre-post study of a pathway to standardize care of patients presenting to a tertiary academic Veteran's Health Administration ED with asymptomatic hypertension.

The predictive value of heart rate in determining clinical course after a bupropion overdose.

Introduction: Bupropion is a popular antidepressant due to its favorable side effect profile and indications for smoking cessation and weight loss. Due to the possibility of delayed onset seizure and other adverse outcomes after bupropion overdose, patients are often observed for periods of 12-24 hours following suspected ingestion. Tachycardia is a clinical predictor that holds promise in differentiating cases at risk for seizures from low-risk cases that do not require prolonged observation.

Auditory aversive generalization learning prompts threat-specific changes in alpha-band activity.

Pairing a neutral stimulus with aversive outcomes prompts neurophysiological and autonomic changes in response to the conditioned stimulus (CS+), compared to cues that signal safety (CS-). One of these changes-selective amplitude reduction of parietal alpha-band oscillations-has been reliably linked to processing of visual CS+. It is, however, unclear to what extent auditory conditioned cues prompt similar changes, how these changes evolve as learning progresses, and how alpha reduction in the auditory domain generalizes to similar stimuli.

Moving toward reality: Electrocortical reactivity to naturalistic multimodal emotional videos.

While previous research has investigated the effects of emotional videos on peripheral physiological measures and conscious experience, this study extends the research to include electrocortical measures, specifically the steady-state visual-evoked potential (ssVEP). A carefully curated set of 45 videos, designed to represent a wide range of emotional and neutral content, were presented with a flickering border. The videos featured a continuous single-shot perspective, natural soundtrack, and excluded elements associated with professional films, to enhance realism.

Emergency department visits at Veterans Health Administration hospitals related to alcohol intoxication: A ten-year retrospective.

We sought to quantify and describe the volume of emergency department visits related to alcohol intoxication at the Veterans Health Administration (VHA), the largest healthcare system in the United States. This is a retrospective cohort study of patients with VHA emergency department visits for alcohol intoxication from 2010 to 2019 as identified via ICD-9/10 code and/or serum ethanol concentration >50 mg/dL. Encounters were identified and demographic and clinical data were acquired by automated query of the VHA Corporate Data Warehouse.

A 5-min paradigm to evoke robust emotional reactivity in neuroimaging studies.

The advent of the Research Domain Criteria (RDoC) approach to funding translational neuroscience has highlighted a need for research that includes measures across multiple task types. However, the duration of any given experiment is quite limited, particularly in neuroimaging contexts, and therefore robust estimates of multiple behavioral domains are often difficult to achieve. Here we offer a "turn-key" emotion-evoking paradigm suitable for neuroimaging experiments that demonstrates strong effect sizes across widespread cortical and subcortical structures.

Emotional Perception: Divergence of Early and Late Event-related Potential Modulation.

The early posterior negativity (EPN) is a mid-latency ERP component that is reliably enhanced by emotional cues, with a deflection beginning between 150 and 200 msec after stimulus onset. The brief, bilateral occipital EPN is followed by the centroparietal late positive potential (LPP), a long duration slow-wave that is strongly associated with emotional arousal ratings of scenes. A recent study suggests that the EPN is particularly sensitive to human bodies in scenes, independent of emotional intensity.

Outcomes of law enforcement officer administered naloxone.

Objective: Law enforcement officer (LEO) administered naloxone is an effective intervention for treating prehospital opioid overdoses. Our objective is to determine the rate and factors associated with adverse behavioral effects and efficacy following LEO naloxone administration.

Methods: This is a retrospective cohort study of patients treated with naloxone law enforcement over 5 years in one county EMS system.

What is the role of the multidisciplinary team meeting in primary prolapse surgery and are alternative formats acceptable?

Introduction And Hypothesis: In 2019, the UK National Institute for Health and Care Excellence (NICE) recommended discussion of all primary prolapse cases at a multidisciplinary team (MDT) meeting prior to surgery. However, following the COVID-19 pandemic, face-to-face meetings were suspended. The aim of this study was to evaluate the role of MDT meetings in an observational retrospective review of primary prolapse cases and determine whether alternatives to face-to-face MDT meetings such as virtual and remote paper result in different outcomes.

QTc Prolongation in Poison Center Exposures to CredibleMeds List of Substances with "Known Risk of Torsades de Pointes".

Many drugs carry some risk of QT interval prolongation, which can lead to life-threatening dysrhythmias including Torsades de Pointes (TdP). CredibleMeds.org identifies medications categorized as "Known Risk of TdP" but does not stratify risk in acute supratherapeutic ingestions.

Poison center consultation reduces hospital length of stay.

Context: Prior studies have observed shorter lengths of stay when practitioners consult a US poison control center (PCC) regarding hospitalized toxicology patients, but the most recent study used data from 2010. Since then, the implementation of the Affordable Care Act, a trend toward shorter hospitalizations and substantial adjustments in hospital charges have occurred.

Methods: This is a retrospective study of administrative hospital data and poison center data obtained from the Wisconsin Hospital Association and Wisconsin Poison Center for patients treated from 2010 to 2017.

Do rare emotional scenes enhance LPP modulation?

The slow wave late positive potential (LPP) is one of the most dependable measures of emotional processing in human neuroscience. While LPP positivity shows modest malleability by emotional regulation and competing tasks, its fundamental enhancement by emotional scene perception is extremely reliable. Here we assess the impact of emotional scene frequency (67%, 50% and 17%) on the strength of LPP modulation, across 3 groups of participants, using consistent presentation and analysis methods.

Routine Laboratory Screening for Acetaminophen and Salicylate Ingestion in Preadmission Psychiatric Patients Is Unnecessary.

Study Objective: Screening preadmission psychiatric patients for acetaminophen or salicylate overdose is unnecessary in the absence of specific clinical concern for medication ingestion.

Methods: This was a multicenter retrospective cohort study of 3 Veteran's Administration emergency departments that medically evaluate patients prior to psychiatric admission. During the 10-year study period, these departments followed screening protocols that required the measurement of acetaminophen and salicylate levels on every patient prior to psychiatric admission.

Humor and emotion: Quantitative meta analyses of functional neuroimaging studies.

Humor is a ubiquitous aspect of human behavior that is infrequently the focus of neuroscience research. To localize human brain structures associated with the experience of humor, we conducted quantitative activation likelihood estimate (ALE) meta analyses of 57 fMRI studies (n = 1248) reporting enhanced regional brain activity evoked by humorous cues versus matched control cues. We performed separate ALE analyses of studies that employed picture-driven, text-based, and auditory laughter cues to evoke humor.

Evaluation of bladder shape using transabdominal ultrasound: Feasibility of a novel approach for the detection of involuntary detrusor contractions.

Conventional assessment of overactive bladder syndrome uses invasive pressure-measuring catheters to detect bladder contractions (urodynamics). We hypothesised that bladder shape changes detected and measured using transabdominal ultrasound scan could provide a non-invasive and clinically useful alternative investigation of bladder contractions. This feasibility study evaluated a novel transabdominal ultrasound scan bladder shape test during conventional urodynamics and physiological bladder filling.

Re-evaluation of histological findings after colocystoplasty and gastrocystoplasty.

Introduction: The potential of malignant transformation and its risk factors after bladder augmentation performed in childhood are still unknown. The necessity of surveillance cystoscopies and biopsies has been questioned in the past decade.

Objective: In a previous study, the authors did not detect any malignancy after colocystoplasty (CCP) or gastrocystoplasty (GCP) during the short-term follow-up, however, various alterations of the mucosa were found.

Stillbirth: Perceptions among hospital staff in the Middle East and the UK.

Objectives Stillbirth is an important and yet relatively unacknowledged public health concern in many parts of the world. Public awareness of stillbirth and its potentially modifiable risk factors is a prerequisite to planning prevention measures. Cultural and regional differences may play an important role in awareness and attitudes to stillbirth prevention.

Emotional and feature-based modulation of the early posterior negativity.

The early posterior negativity (EPN) has been shown to be enhanced by emotional relative to neutral scene perception. A subset of studies has also reported a bias in the EPN toward pleasant relative to unpleasant scenes. Functional MRI research has also identified a region in lateral occipital cortex that shows a sensitivity to the visual perception of body parts, which may contribute to the EPN.

Photoperiodic Requirements for Induction and Maintenance of Rhythm Bifurcation and Extraordinary Entrainment in Male Mice.

Exposure of mice to a 24 h light:dark:light:dark (LDLD) cycle with dimly illuminated nights induces the circadian timing system to program two intervals of activity and two intervals of rest per 24 h cycle and subsequently allows entrainment to a variety of extraordinary light regimens including 30 h LDLD cycles. Little is known about critical lighting requirements to induce and maintain this non-standard entrainment pattern, termed "bifurcation," and to enhance the range of apparent entrainment. The current study determined the necessary duration of the photophase for animals to bifurcate and assessed whether requirements for maintenance differed from those for induction.

What Is the Effect of Body Mass Index on Subjective Outcome Following Vaginal Hysterectomy for Prolapse?

Purpose: Obesity is a significant risk factor for pelvic organ prolapse (POP), but the effects of obesity on outcomes of surgery for POP are poorly understood. The aim of this study was to assess the relationship between POP symptomatology, subjective outcomes of surgery and body mass index (BMI) in women undergoing vaginal hysterectomy for POP.

Methods: Pre- and postoperative data from a validated pelvic floor questionnaire (electronic Personal Assessment Questionnaire-Pelvic Floor) were collected prospectively from 60 women undergoing vaginal hysterectomy for POP.

Pulmonary Complications of Opioid Overdose Treated With Naloxone.

Study Objective: We aim to determine whether administration of higher doses of naloxone for the treatment of opioid overdose is associated with increased pulmonary complications.

Methods: This was a retrospective, observational, cross-sectional study of 1,831 patients treated with naloxone by the City of Pittsburgh Bureau of Emergency Medical Services. Emergency medical services and hospital records were abstracted for data in regard to naloxone dosing, route of administration, and clinical outcomes, including the development of complications such as pulmonary edema, aspiration pneumonia, and aspiration pneumonitis.

Treatment of Ventricular Fibrillation Due to Ammonium Bifluoride Poisoning With Hemodialysis.

Ammonium bifluoride is an inorganic, fluoride-containing compound found in glass and metal etching products, as well as wheel cleaners. Fluoride toxicity is a common cause of preventable poisoning and has been reported to cause life-threatening ventricular dysrhythmias. Here, we report a case of recurrent ventricular fibrillation secondary to ingestion of ammonium bifluoride.